Creating a Pain Management “No Man’s Land”

Creating a Pain Management “No Man’s Land”

By Steve Ariens P.D. R.Ph.

Having been a “student” of our bureaucracy/bureaucrats/politicians for some 3+ decades it is easy to see that there are seldom any major moves, only numerous “tweaks” to existing laws/rules/regulations. After Congress created the “black drug market” with the passage of The Harrison Narcotic Act in 1914, The USA has consistently had about 1% +/- of the population that are serious illegal substance abusers for the last century.

Starting in the year 2000, the Joint Commission decided that “pain management” was the fifth vital sign and that hospitals were expected to address pt’s pain levels throughout the pt’s stay in the hospital.

It shouldn’t surprise anyone that this focus on a patient’s pain became not only a “fifth vital sign” in the hospital setting, but also pain started getting increased attention in the ambulatory setting.

As a result, many patients who were dealing with undiagnosed mental health issues – like additive personality disorders – were exposed to opiates. The outcome was pretty predictable, a few percent of them received opiates for their pain, ended up going down the path to addiction.

Steve Ariens

This is not to say that these people would not have started down this path of abusing some legal/illegal substance without this first legal interactions with a opiate.

More and more bureaucrats/politicians seem to have come to the conclusion that all people who are abusing/addicted to legal/illegal opiates because they had been given a prescription for some opiate to treat some acute pain. They have also come to the (false) conclusion that if they limit the days supply of opiates prescribed for acute pain, these people would never start using heroin or some other illegal opiate and opiate OD’s would cease to happen.

Chronic pain is generally described as someone needing opiates for more than 90 days. If our bureaucracy is creating three, five or seven days supply limits on legal prescription(s) for acute pain, are they hoping that no one will qualify for long term use of opiates for chronic pain, since no newly diagnosed pain patient can be prescribed opiates for their pain and reach the 90 day threshold to be considered a chronic pain patient?

Anyone with three brain cells holding hands can realize that we are going to get newly diagnosed patients that will be in need of long term opiates for the pain associated with their chronic disease and/or pain resulting from a serious accident.

So what is the potential problems with this “no man’s land” between a prescriber being able to treat acute pain and treating newly diagnosed pt that will be suffering from pain that will end up being treated for chronic pain?

Will this “no man’s land” be used by our judicial system to ID prescribers who are treating chronic pain pts that fall into this “opiate limbo” as “pill mills” and used it as justification to raid the prescriber’s office, seize their assets and shut them down? Or will it just be used it as further method of intimidation of prescribers to deny pain pts with their medically necessary therapy ?

We have all seen that there seems to be little that our judicial system will not do, to keep the funding of the war on drugs justified to Congress.

Steve Ariens is a retired pharmacist who is a frequent contributor to the National Pain Report.

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There are 20 comments for this article
  1. F.S.T. at 5:28 am

    A great post and equally great comments. Thank you, Steve. I do hope the powers-that-be are at least listening to you, a professional. They certainly aren’t listening to us, the chronic pain community. I’ve been emailing my Congress people for two years now, with the polite “thank you yes we’re looking at the CRISIS” (emphasis mine) standard response, so now we all know THEYRE NOT LISTENING. I’ve all but given up.

  2. Dave at 3:02 pm

    Our established agencies will fight tooth and nail when it comes to the $$$ the receive I honestly believe this is why they are so opposed to the treatment methods other countries such as Switzerland or Portugal have put into practice, Look at the associated decrease in crime and associated costs as this would mean less people committing crimes, less people being arrested, and imprisoned. Less $$$ wasted on efforts that have been proven not to work , But that would also mean less $$$ for they’re budgets which cannot be allowed in they’re eye’s no matter what. Sadly to say the end goals are not truly geared towards saving lives and convincing those addicted to get into treatment here in our country and until we realize this and truly work to make changes and incentives to get those who are addicted into treatment and to take the needed steps to get them back into society as contributing members things will not get better

  3. Mark Ibsen MD at 10:14 pm

    12 days ago
    In Las Vegas
    560 new chronic pain patients were inducted by a crazed sniper.
    Think they will
    Only need 3 days?
    7 days of pain Rx?

    The way to ensure they don’t become chronic pain statistics is to treat their acute pain.

    Can someone show me ANY evidence for a benefit of under treating acute pain this way?
    Could anyone even get an IRB review for a study to under treat pain?
    It’s inhumane.
    The Cochran review showed 1% rate of addiction.
    This is all so absurd, unnecessary
    And
    Non-Hippocratic.

    Time will show the insanity of these policies.
    I just hope not too many die
    While this crazy shit runs its course.

    Really?
    Regulators and
    Agents
    Practicing medicine without a license?

    Guess we don’t need doctors
    Or
    Pilots
    Lawyers
    Engineers
    Politicians

  4. Paul at 4:28 pm

    Steve – excellent article. I have been thinking of this same problem recently. In 2010 I had a routine hernia surgery. Unfortunately, I was part of that 1%-30% of patients who end up with chronic pain (it depends on whose statistics you believe). I can’t imagine what I would have done between day 7 and day 90 for pain relief. It was hard enough getting the doctors to believe I was in such extreme pain!

  5. Steven R. at 11:06 am

    As always, Steve has written another great article. An article that depicts the over-reach our our government into our healthcare. That has been going for many years in the debate over woman’s health decisions. The government officials think they know what’s right when it comes to doctors and how they treat their patient’s. The government seems to always do is what’s best for the insurance industry and other lobbying groups and not the publics best interest. Just look at the new adminstration for how their gutting healthcare for everyone in an effort to apease their donors, The Insurance Industry, that’s poured millions into politics to garner support for them and not forcthe public who voted for them. The Young Turks started Wolf-PAC as a non profit organization to get money out of politics. Things will only get worse if the many millions of dollars in donations/bribes keeps our politicians beholden to lobbyists an not their voters as they should be.

    Steven R.

  6. BL at 7:25 pm

    Each state that has enacted laws limiting opioids for acute pain to a few days has exceptions to those laws.

  7. Connie at 5:30 pm

    I can only hope that karma bites hard all these people who are practicing medicine without a license! I am feeling quite vindictive and hope they all suffer what we do daily!

  8. Alison at 3:40 pm

    Sigh. Yet more inconsistencies being pointed out in our country’s bureaucratic push for stupidity. I am so tired of all these hits to chronic pain patients, such as myself, that I can’t come up with anything more intelligent to say…except thank you Steve Ariens for pointing this out. And perhaps someone with more than the described three brain cells with the power to implement a change just might read this.

  9. Chris S. at 2:53 pm

    Thanks for speaking up Steve. I’ve written letters ( 3-4 waves of 9 letters ) to every politician in my state with very little response. Most have NOT replied at all and the one’s who did reply DID NOT address the question of a one blanket policy to fit ALL chronic pain patients because of the small percent of law breaking patients that can’t follow the the prescription bottle directions and laws. Why does the other 98% of ‘ responsible chronic pain patients ‘ who have been taking opioids for a successful working a treatment, which is cost effective for the patient, better quality of life for the patient, whom has been taking legal pain medication for decades have to suffer miserably with relentless needling chronic pain. WHY ? I’ll bet if the shoe of the chronic pain was on their foot or their wives or child’s ( politicians ) the policies would be very different. See how these folks would deal with debilitating life changing chronic pain 24/7. They ( politicians ) took away, the number 1 treatment to combat chronic pain. Some of us, depended on pain medication as we have for years for our quality of life. I myself, (65) endured (5) failed spine surgeries from 1996 through 2001, titanium rods and screws in 5 levels of the lumbar spine can only depend on the pain medication treatment. The pain clinic treatments do not help me and cost a great deal of money and the treatments are never ending. Pain clinic treatments do not work for me. The politicians did the exact same thing to allergy/sinus medication ( blanket policy ) because a small percentage of druggie’s were making illegal drugs from the allergy medications we all depended upon for sinus/allergy relief. All these government blanket decisions are to fight the war on drugs. Who decides to make us all suffer in misery for the 1% or 2% of law breakers ? They are doing the same with pain opioid medications ? How is this fair to the other 98% of law biding chronic pain patients ? Why should the law following majority suffer miserably for the minority of the law breaker’s or those who CHOOSE to abuse drugs ? Who decided to take trained physicians fighting chronic pain in the daily trenches in the lives of all their innocent patients whom which they know by name and remove the physician’s medical power to assist his patient’s ? These decisions are causing unnecessary debilitating pain, relentless misery, extreme suffering and death. Where is the common sense in this type of decision making. What if the government applied this blanket policy changes to other parts of the medical field and removed heart, cancer, kidney, lungs and other pain medications that helped certain groups of patients. What the politician’s and government agencies have created this persecution of the innocent chronic pain patient to conspire and further their nationwide blanket policy agenda’s for their gain is unconscionable. They are responsible for the misery, pain, suffering and death of these injured, disabled, dying person’s by taking one of their most successful form of medical treatment. Remember your politician’s in November and every time you vote. Remember their opioid policies. Please look at the person running. This seems to be the ONLY power we have as American’s especially if the politician’s do not answer your letters or request for town-hall meetings because they are afraid to be confronted. We should think about TERM LIMITS on EVERY politician in this country. Same as the president, 8 years and can no longer run for that office again for EVERY politician in office. The complacency of each and every politician in our country needs to be examined closely. I still have hope that we the people can one day live in our country with out all the political correctness to a fault, its hurting the country and common sense decision making for the good of ALL the people and not for political agendas, political power and wealth for individual’s or certain groups. Thanks

  10. Bob Schubring at 12:49 pm

    With few exceptions (notably some cancers), early detection of illness happens with the onset of pain. Someone who collapses with a chest pain, is rushed to the hospital and examined for signs of a heart attack. The chest pain is the Vital Sign that first alerts the patient that a heart attack may be happening.

    Sensibly, clinicians should consider a worsening pain, as they would consider a worsening of any other symptom. Worsening symptoms mean the disease is getting further out of control.

    It is only because of the politics that began with the 1914 Harrison Act, that American clinicians react with fear to a worsening pain, imagining that the magic of the pain medicine magically stopped working…or that a jury might be persuaded of that, if someone sues them. In rational nations, the response to a worsening pain is to re-check the diagnosis to see if something was missed initially. In too many American hospitals, the response to a worsening pain is to abandon the patient.

    A recent letter from the White House Office of National Drug Control Policy signed by NJ Gov Chris Christie, states “While this crisis is very real, it is also important to recognize that addiction is a disease and it can be treated. Arresting, jailing and stigmatizing these victims will not make it better.” The concept is 103 years late, and still does not go far enough, in recognizing the damage done by false information circulating about pain and it’s treatment. Worse yet, it fails to grasp the economic impact of constructing a healthcare system that ignores the meaning of pain, when assessing whether someone is recovering or getting worse. We’ve built an extremely-inefficient healthcare system that assumes every patient might be lying about pain. which then tries to force unnecessary treatments upon people.

  11. Ibin at 12:39 pm

    Pain management of the patient greater than 90 days is a medically necessary treatment that is, will, and has been a negative health occurrence here in America…..and the world for decades. IF the physician is treating the patient with appropriate measure, then the patient has been treated with the least…..invasive method as per the health condition. For MANY patients the evil opioid medication IS the last, effective treatment for chronic or palliative pain management. There is NOT one effective pain management relief for one and all, including oipiod medication as the CDC is “leading” non pain Americans to “believe”.in. This “policy” is causing worsening pain, emotional stress, monetary loss and DOES NOT mean that the patient is simply…..an addict, in my opinion. Pain generating disease, surgical goof ups, less than perfect surgery is,have, will, and always shall be an occurrence. To limit a treatment because of cost, possible dependence on medication is NOT a valid reason to “purge” from society those that through no cause of their own fall into the chronic or palliative care patient category. Physicians are only treating, performing surgery to the “best” of their ability. The “best” of their ability is very often not effective enough to manage life time pain without oral medication, opioid medication. There can be a dosage that is effective, without increase for years, possibly a life time. This dosage “may” limitmobility, the ability to perform previous “normal” function but, it is a hell of a lot better than lying awake all night, inability to maintain everyday functions such as food preparation, food source gathering, personal hygiene and slip into total complete emotional decay yet, the “experts” have the remedy for one and all. The CDC will study how we can treat patients with lifetime pain “better”……in the future but, for many responsible patients the problem has been initiated through the CDC current “policy”. I have heard it stated that these patients are being “purged” from society, unjustly. The “policy ” from the CDC IS causing, wreaking havoc from the young to the elder with blatant disregard of our providers documentation of beneficial, successful use of medication. Providers with decades of documentation proving that the benefit of opioid medication is the last effective treatment for many millions of patients The CDC “policy” of 90 mme daily, maximum, for one and all IS an irresponsible action of regulation without the input of our providers and the worsened situations inclusive of monetary loss (job loss), negative emotional tendencies documented cases of suicide. all with what was previous to the CDC policy, managed life time pain The prescribed patients in this nation are taking the blame for ALL addiction of both illicit and prescribed medication while evidence is and has been documented that millions of patients were having a much better pain management life than before the “policy” The”policy” at the very least should allow some variance with documentation before reducing any and all patients to 90 mme ,daily, maximum. Jobs lost, personal sovereignty, inability to remain self sufficient in ANY capacity has been lost with the “experts” opinions without the reality of what MANY patients are realizing with 90 mme. I believe all patients with life time pain have been much better managed IF the experienced judgement of pain management were left to the physicians that have been managing pain for decades. DOT/GOV has taken a hardline approach at social reform, conformity among all patients with life time pain. For the life time pain management patient we HAVE conformed to the “rules” of pain management, most for decades with beneficial, successful use with opioid medication as the last, effective pain management treatment. There is always room for improvement in the field of pain management but, the CDC “policy” of 90 mme dailly is NOT it.

  12. Teresa Chalk at 12:31 pm

    Thank you so very much for writing this!!! I am a chrobic pain patient and have been for over 10 years…..I have been denied ANY pain meds since getting out of the hospital last January from having a severe attack if my Hereditary Coporoporphyria and Immune Thrombocytopenic Purpurea….causing my kidneys to shut down for the 3rd time, another mini stroke and my first heart attack in addition to making my visceral and peripheral neuropathy more extensive.

    Teresa Chalk 🙂

  13. Terry Longtin at 12:19 pm

    Blah, blah, blah, blah. It’s happening right now! Every day hundreds of chronic pain patients are being dropped by so called pain management doctors and forced to go through horrible withdrawals and their future is filled with horrible, debilitating chronic pain! So we don’t need someone pointing out what everyone already knows, we need solutions to what we can do, TODAY, to stop the paranoia, overreacting and incorrect statistics that the government is spreading. How do I stop my pharmacy, yeah you heard me right, my pharmacy from reducing the amount of pain medication that was PRESCRIBED by a PAIN MANAGEMENT DOCTOR! What oh what are we to do? It’s terrifying to say the least. I was a high functioning chronic pain patient when I was prescribed quite a high amount of pain medication for my ailments. I never failed a urine test in ten years, my symptoms were exhaustively documented, along with being a rapid metabolizer, an enzyme I’m my liver that causes medication to go through my system four times faster than normal and has half of its normal affectiveness. See, everybody is different but our stories are the same. This is a national emergency and needs to be addressed immediately! The suicide rate will definitely be going up as well as lawsuits for chronic pain patients. If there is something that I can do to help the chronic pain community I would gladly do it. I’ve emailed my congressman and senators, I have received one response from one of my congressmen, Henry Yanez (Michigan), but his response was that of understanding and agreeing that the opiate “epidemic”, was a problem. At least he responded, lame as it was. So please if anyone has anything that we can do as in the chronic pain community, please advise us. I am willing to pass around petitions, write to senators, March on Washington, whatever! There must be something as United States citizens! We have rights and they’re being trampled on because of a lot of misinformation by, who else, our embarrassing government. Do you think Trump is going to help us? He’s a bigger joke yet. So come on everyone, let’s brainstorm, let’s hear from some attorneys and see what we can do! This is the rally cry! I honestly don’t know what to do.

  14. Elise Jayne at 10:26 am

    The Prescription Management business model has launched a direct assault on chronic pain,cancer and palliative care patients in a Trojan horse effort to deny access to benefits and save money. The fact that they are granted immunity to practice medicine without even having licenses to do so through the mail to make unauthorized reductions to legitimate prescriptions to lower their own cost spreadsheet at the expense and quality of life of others is egregious . Licensed doctors have had careers destroyed and been made accountable for far less…So permitting corporate business management teams to have a free pass around practicing medicine across the nations states under the false aegis that they are the great social hope through denial of access to a valid patient’s right to treatment and care is as disingenuous as it is abusive. People need to pull back and expose the greedy little corporate insurance bastard that is ecstatic over the growing profits sheet and hiding behind the proverbial curtain….

  15. Ellie at 9:27 am

    Great article Steve! As always on point & interesting. Need 2 know what I can do personally to get through 2 these legislators creating this fake crisis. I have written to my states representatives & unfortunately all I received in return is ” we received your email”. I will continue to flood their offices with more emails but want to know what else I can do! I read your twitter line daily & as always very eye opening. Grateful to have you in our side please know that! Keep on fighting the good fight!

  16. Mist at 6:55 am

    Good morning america ,had a segment on 9 million pills sent to a small town ..according to them 500,000 people have died since 2000 from pills..when will they ever report the other side ?

  17. Maureen Mollico at 6:48 am

    Steve, ‘Thank you’ for yet another well put and neatly written post of realization!
    So far my Pain Management Doc does not seem to be backing down re: my medication. Although, he is never interested in discussing my pain issues/changes nor changing my meds accordingly etc.
    It is always ‘in the air’ in the exam room that I am lucky that I get my script and let’s just keep it status quo!
    Each time I see another commercial or video re: the war on Opiods I could scream. And sometimes I certainly do make out loud comments to them! 🙂
    I want to see the same on TV re: the Chronic Pain community and our side of the issue.
    Simply, we CANNOT stop making noise from our side. We must keep strong and vigilant…for this is OUR LIVES they are greatly effecting.
    Keep strong Steve…and CP warriors!

  18. R. John Donahue at 5:20 am

    Where are the real doctors? Those now rare, actually competent and empathetic doctors capable of the logic that you, Ariens, so clearly display?

    Thank you for using your brain, unlike the “doctor” masses whose faith in the prevailing dogmas of beaucratic groupthink & newspeak willfully blinds them to the pain-decimated human individuals suffering right in front of them.

    Thank you for writing Truth to Power, however hopeless the plight seems to those of us who’ve lost everything due to these arrogant sadists in angelic white coats.

    Gratitude to you, sir, as a True Pharmacist and True Human.

  19. Sharon D at 3:50 am

    Amen. Also, being in constant pain stresses your body’s systems, especially your heart (pulse rate and BP) leading to a shortening of life.

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